An extensive review was made, using a search of the literature and study of the files of the Pathology Branch, NHLBI of the pathologic anatomy of coronary arterial lesions that occur in various types of familial and metabolic diseases. Different patterns of morphologic alterations in the coronary arteries were recognized as occurring in association with certain types of disorders . The pathogenesis of these changes was discussed in detail in terms of the associated metabolic lesion.